Styloid and hyoid relationship

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styloid and hyoid relationship

Styloid process length and styloid/hyoid bone proximity to the internal carotid artery (ICA) have been implicated in certain carotid pathologies (e.g. carotid artery. On palpation of the right tonsillar fossa, tender elongated styloid process from right styloid process extending towards the hyoid bone below the angle of . However, the complete details of length, angulation and relation to. styloid process, ossified stylohyoid ligament, or elongated hyoid bone. . were performed of the bony anatomy to show spatial relationships.

The first description of a syndrome of vague orocervicofacial pain was in by Watt Eagle, MD, an otolaryngologist. Keur et al 7 found the incidence of elongated styloid processes to be equal in men and women, although women displayed symptoms consistent with Eagle syndrome more frequently. Eleven years after Eagle first made his diagnosis, he described 4 2 classifications of the syndrome: Eagle syndrome has also been reported in the neurosurgical literature as a cause for transient ischemic attack in a patient presenting with severe reversible narrowing of the internal carotid artery ICA on head movement to the affected side.

This patient was treated successfully by transcervical styloid process excision with resolution of symptoms. Camarda et al 9 previously classified this constellation of symptoms into 3 distinct entities: Eagle syndrome as classically described with prior trauma, stylohyoid syndrome, and pseudostyloid syndrome.

Stylohyoid syndrome was the most common of the 3, and applied when a patient's symptoms appeared earlier in life owing to a developmental anomaly of ossified stylohyoid ligaments or elongated styloid processes, with no associated trauma. Pseudostyloid syndrome is caused by tendinosis at the junction of the stylohyoid ligament and the lesser cornu of the hyoid in older individuals with no history of trauma and no evidence of styloid process elongation or stylohyoid ligament ossification on radiologic examination.

We have seen that 3 different pathologic conditions within the SHC—elongated styloid process, ossified stylohyoid ligament, and an elongated hyoid bone—can cause the same symptom complex. Symptoms can include lateral neck and oropharyngeal pain in the area of the submandibular space and deep to the angle of the mandible exacerbated by chewing, swallowing, speaking, and head movement.

We believe that the symptoms are related to the tension of the SHC that irritates surrounding structures with head and neck movement owing to the lack of distensibility of the complex.

The Hyoid Bone - Structure - Attachments - TeachMeAnatomy

Surgery to interrupt this complex at any point is likely to improve the symptoms by relieving the tension of the SHC. We suggest a new diagnostic classification of stylohyoid complex syndrome SHCS to include the previously described Eagle syndrome, stylohyoid syndrome, and pseudostyloid syndrome because all entities originate from pathologic conditions within the SHC. Herein, we review our series of patients with SHCS. Demographic data, presenting symptoms, radiologic findings, surgical procedures, and outcomes were gathered.

Patients were asked to rate the percentage improvement of their pain symptoms at the first postoperative visit approximately 2 weeks after surgery and at all subsequent visits. Results Seven patients 8 sides were identified. The age range was 38 to 53 years at the time of presentation mean age, Five of the 7 patients were female. Common presenting complaints were lateral neck and oropharyngeal pain exacerbated by tongue and head movements, with tenderness over the affected structures when palpated during these activities.

All patients underwent computed tomographic CT scan of the neck with contrast with multiplanar reconstructions, and when necessary 3-dimensional volume-rendered reconstructions were performed of the bony anatomy to show spatial relationships. The pathologic conditions identified on CT imaging included 3 elongated styloid processes 1 bilateral2 ossified stylohyoid ligaments, and 3 elongated hyoid bones.

styloid and hyoid relationship

One of these patients had bilateral ossified stylohyoid ligaments, and 1 had bilateral elongated styloid processes, but each underwent unilateral resection due to unilateral symptoms. Two patients had a history of trauma or tonsillectomy. The surgical approach was determined by the location of the pathologic conditions along the SHC identified on examination and imaging.

All operations were performed in a same-day surgical suite under general anesthesia, and patients were given perioperative antibiotics. The surgical approaches were as follows.

styloid and hyoid relationship

The transoral approach was used to resect the elongated styloid processes. The styloid process was found by palpation of the tonsillar fossa.

The overlying mucosa and superior constrictor muscle were incised vertically and the styloid process dissected out and skeletonized using a right-angled clamp. If necessary for exposure, a standard tonsillectomy was performed first. The stylohyoid ligament was isolated and resected off of the tip of the styloid process. The styloid process was then transected as high as possible. The superior constrictor muscle and mucosa were closed with interrupted absorbable sutures.

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Ossified stylohyoid ligaments and elongated hyoid bones were resected through cervical incisions. In cases in which the stylohyoid ligament was ossified, an approach similar to that used for a submandibular gland resection was used. A horizontal incision was placed in a skin crease 2 to 3 cm inferior to the mandible, and dissection was carried down to the submandibular gland, taking care to protect the marginal mandibular branch of the facial nerve.

The submandibular gland was reflected superiorly and the parapharyngeal space identified.

An Unusual Case of Bony Styloid Processes That Extend to the Hyoid Bone

The ossified ligament was identified by palpation, isolated from the surrounding structures with blunt dissection, and isolated along its entire length from its origin at the styloid process to its insertion onto the hyoid bone. The entire ligament was resected en bloc with the lesser horn of the hyoid bone and the tip of the styloid process. This resulted in immediate release of the tension in the SHC and an inferior release of the hyoid bone.

For those patients with an isolated elongated hyoid bone, the surgical approach involved a submandibular approach with a slightly more anterior incision.

styloid and hyoid relationship

The greater horn of the hyoid bone was identified, and the lateral portion of the hyoid bone, including the greater and lesser horns, was skeletonized and resected. All patients were discharged home the same day with oral pain medication and oral antibiotics for 7 to 10 days. No steroids were used.

Those patients who underwent a transoral approach were placed on a soft diet. No intraoperative or postoperative surgical complications were encountered.

One patient required an overnight readmission for inability to tolerate oral diet. Five patients experienced complete resolution, and 2 patients had partial resolution of symptoms within 2 weeks following surgical intervention.

styloid and hyoid relationship

The follow-up period was over 1 year in 5 of 7 patients. Comment The differential diagnosis of patients with lateral orocervicofacial pain includes, but is not limited to, glossopharyngeal neuralgia, trigeminal neuralgia, temporomandibular joint dysfunction, temporal arteritis, salivary gland disease, chronic tonsillitis, tumors of the pharynx and tongue base, laryngopharyngeal reflux, dental disease, carotidynia, atypical migraine, otitis media, otitis externa, and mastoiditis.

This embryological malformation clearly supports the hypothesis that the second pharyngeal arch gives rise to the lesser cornu and demonstrates an unusual clinical finding that may be encountered by otolaryngologists. We demonstrate the imaging findings and surgical management of this unusual anatomical variant and review the embryological basis for this rare malformation. Introduction The hyoid is a free floating horseshoe-shaped bone that sits in the anterior midline and serves several functions to assist in swallowing and movement on the tongue.

It also serves as an attachment point for muscles of the pharynx and larynx, including the middle pharyngeal constrictor, hyoglossal, digastric, stylohyoid, geniohyoid, and mylohyoid muscles superiorly and the thyrohyoid, omohyoid, and sternohyoid muscles inferiorly [ 1 ]. These muscles serve as anchors for the hyoid bone as it has no bony attachments. There are two embryologic hypotheses regarding derivation of the hyoid bone.

The first suggests that hyoid bone is derived from the second and third pharyngeal arches.

Mandible and hyoid bone

Evidence from embryological studies examining development patterns of the hyoid, such as the observation of unique fibrous tissue populations between the lesser cornu and hyoid body thereby implying the fusion of cells from two separate origins, has led to the greater acceptance of the theory involving the contribution of the second pharyngeal arch to hyoid bone development [ 23 ].

The clinical entity of calcified styloid ligaments supports this contribution of Reichart's cartilage in the generation of the hyoid bone [ 4 ]. A second, alternate hypothesis states that the hyoid bone and all of its component parts originated from the third pharyngeal arch, which calls into question the notion that the second pharyngeal arch, also called Reichert's Cartilage, plays any role in development [ 35 ]. While studies have examined the relative anatomic variation present in hyoid bone development, opportunities to examine these anomalies, particularly in adults without a history of previous surgery or trauma to the hyoid area, are poorly described in existing literature [ 6 ].

Knowledge of hyoid bone anatomy becomes important during surgical cases of trauma, pediatric otolaryngology, and laryngology where the anatomic relationships between the hyoid bone and its muscular attachments are critical [ 7 ]. In surgical oncology, intraoperative management of the hyoid bone is an important structure for mobilization during open laryngeal surgery. Total laryngectomy is the surgical management of certain advanced laryngeal cancers, particularly those that have progressed beyond the point where chemoradiotherapy alone is sufficient [ 8 ].

styloid and hyoid relationship